In the United States, more than a million hospital discharges are heart failure-related each year. Advanced heart failure patients who face end-of-life may require a left ventricular assist device (LVAD). The LVAD, placed as a bridge to heart transplant or as destination therapy for those who do not qualify for transplant, significantly improves quality of life and functional status. However, emotional distress and psychological sequelae including depression have been noted following device insertion. And, though this therapy does extend life by as much as 4 times over medical management, individuals living with LVAD face multiple post-implant hospitalizations, lifestyle adaptations and end-of-life considerations. The stressful experience of adapting to this device has not been studied using physiological and psychological indicators of stress response. The proposed study will be the first to study physiologic biomarkers and psychological stress response measures. Through a cross-sectional approach, stress response to the LVAD stressor will be measured. This study is informed by a conceptual framework adapted from the Allostatic Load Model and Lazarus and Folkman's stress model. Relationships among salivary cortisol, C-reactive protein, perceived stress and depression and quality of life, functional status and hospitalization rate outcomes will be examined. Statistical analyses will include descriptive statistics and regression modeling. In addition to the proposed research, the accompanying training plan will enable the applicant to become an independent scientist in advanced heart failure research. The applicant, her sponsor, and co-sponsor have laid out a training plan, which includes multiple interdisciplinary cardiovascular research experiences as well as additional coursework and training in relevant topics. The proposed study will make a significant contribution to the study of stress and advanced heart failure and is in direct alignment with the end-of-life research strategic mission of the National Institute of Nursing Research.